betterment  of  life  insurance  S>erbtce 


NEED  FOR 

BETTER  VITAL  STATISTICS 


Report  of  Health  Committee 
Association  of  Life  Insurance  Presidents 


“  Public  Hygiene  is  built  upon  and  directed  by, 
and  is  everlastingly  in  debt  to  vital  statistics. 
.  .  .  Every  wheel  that  turns  in  the  service  ot 
public  health  must  be  belted  to  this  shaft.” 

T)r.  John  S.  Fulton  of  Maryland 

Secretary  General  15th  International  Congress 
of  Hygiene  and  Demography 


Submitted  at  the  Sixth  Annual  Meeting  of 

Association  of  Life  Insurance  Presidents 

at  New  York,  Dec.  5,  1912 


NEED  FOR  BETTER  VITAL  STATISTICS 


To  the  Association  of  Life  Insurance  Presidents: 

Your  Health  Committee  respectfully  submits  the  following  report: 

One  of  the  most  important  and  world-wide  movements  of  the 
present  day  is  the  concerted  attack  on  uncleanliness  and  disease.  It 
is  not  limited  to  our  own  country  and  people ;  it  is  directed  against 
no  one  disease,  but  against  all  the  ailments  which  flesh  is  heir  to. 
It  is  all  the  more  irresistible  because  it  comes  from  so  many  different 
angles.  This  war  is  being  waged  with  constantly  increasing  energy. 
The  medical  profession  has  worthy  allies  in  many  other  branches  of 
science,  in  philanthropy  and  among  business  men  and  business 
institutions. 

Diseases  which  a  few  years  ago  constituted  well-grounded 
cause  for  alarm  because  of  their  contagious  character  and  high  mor¬ 
tality,  have  been  brought  under  subjection  and  practically  eradicated. 

.  Medical  science  has  discovered  new  methods  of  treating  still  other 
;  diseases  so  as  greatly  to  reduce  their  severity  and  consequent  high 
death  rate. 

From  a  layman’s,  as  well  as  from  an  economic  view-point,  the  most 
interesting  and  important  achievements  have  been  the  discoveries  for 
the  prevention  of  disease. 

It  has  been  the  ambition  of  this  Association  to  bear  a  modest  part 
in  this  great  movement  and  to  lend  a  helping  hand  toward  the  con¬ 
servation  of  human  life.  While  the  Association  is  not  organized 
primarily  for  such  purposes,  yet  every  thinking  person  must  admit 
that  they  have  a  direct  relationship  to  the  business  in  which  the  mem¬ 
bers  of  the  Association  are  engaged;  and  consequently  are  proper 
subjects  for  the  consideration  of  the  Association  itself. 

Every  policyholder  is  directly  interested  in  the  actual  mortality 
experienced  by  his  Company;  and  is  indirectly  interested  in  the 
hygienic  condition  of  the  communities  in  which  all  the  policyholders 
live,  and  from  which  future  accessions  to  membership  must  be 
1^5  obtained. 

The  National  Government,  many  State  Governments,  National, 
State,  County  and  local  organizations,  civic  and  social  clubs  and 

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r  / 


societies,  special  exhibits  and  special  trains,  are  contributing  largely 
and  successfully  to  the  work  of  general  and  special  hygiene  and  to 
the  prevention  and  eradication  of  disease.  This  Association  so  far 
has  contributed  its  mite  largely  through  a  campaign  of  publicity  and 
education.  Some  of  the  foremost  specialists  in  their  particular 
branches  have  delivered  addresses  which  have  been  given  very  wide 
publicity.  Many  of  our  members  little  realize  how  widely  these  ad¬ 
dresses  and  the  press  notices  of  them  have  been  disseminated.  Ad¬ 
ditional  impetus  has  been  given  also  to  the  work  by  our  individual 
members  and  by  their  officers  and  directors,  both  by  bulletins,  Com¬ 
pany  publications,  and  personal  addresses  before  local  organizations. 

One  of  the  serious  questions  which  we  have  repeatedly  asked  our¬ 
selves  has  been,  “What  can  we  do  best  and  how  can  we  best  do  it?” 
Some  of  our  members  have  thought  that  a  general  campaign  of  ed¬ 
ucation  by  the  way  of  public  addresses  and  through  the  public  press 
was  about  all  that  we  could  do.  Others  have  suggested  that  the 
Association  should  apply  itself  more  particularly  to  the  betterment 
of  local  hygienic  conditions ;  taking  some  particular  place  or  places 
as  typical  of  others  in  which  to  make  the  initial  move ;  still  others 
have  thought  that  the  Association  should  select  some  disease,  as 
typhoid  fever,  and  for  the  time  being  concentrate  all  our  batteries 
on  it. 

When  there  is  so  much  to  be  done,  and  so  great  a  field  in  which 
to  do  it,  it  is  a  most  difficult  task  to  determine  what  to  attempt  first. 
It  matters  not  how  much  the  National  and  State  Governments  and 
independent  societies  and  organizations  may  do ;  the  actual  results, 
whether  applied  to  the  cleaning  up  of  towns  and  cities,  the  furnish¬ 
ing  of  water  and  milk  to  the  individual  consumer  free  from  bacteria 
and  harmful  germs,  or  to  the  prevention  or  healing  of  diseases,  must 
be  local  in  character  and  must  be  brought  about  largely  through 
local  sentiment,  working  through  local  people. 

The  important  question  then  is,  “How  can  local  public  sentiment  be 
aroused  sufficiently  to  accomplish  these  results  ?” 

A  year  ago  an  appropriation  was  made  by  the  Association 
to  be  used  in  securing  additional  assistance  in  connection  with 
the  work  of  its  Health  Department.  In  a  general  survey  of  so  broad 
and  varied  a  field  no  one  phase  of  the  work  appeared  to  offer  an 
especially  favorable  opportunity  for  making  a  successful  attack  with 
the  money  available. 

The  International  Congress  of  Hygiene  and  Demography  held  at 

2 


Washington,  D.  C.,  in  September  last,  seemed  to  offer  a  rare  oppor¬ 
tunity  for  your  committee  to  view  the  whole  subject  from  many  dif¬ 
ferent  angles,  and  perchance  definitely  decide  along  what  particular 
lines  the  Association  can  best  work  in  the  future. 

A  meeting  of  the  Committee  was  called  for  the  afternoon  of  the 
first  regular  day  of  the  Congress.  All  of  the  members,  excepting 
two,  were  present ;  one  being  detained  by  illness,  and  the  other  by  an 
unavoidable  business  engagement.  At  such  meeting  the  official  pro¬ 
gram  of  the  Congress  and  the  published  abstracts  of  the  addresses 
to  be  given  were  gone  over  carefully,  page  by  page,  and  the  members 
of  the  Committee  were  assigned  to  attend  different  sections  of  the 
Congress  in  its  morning,  afternoon  and  evening  sessions.  Those 
particular  lectures  on  both  hygiene  and  demography  were  selected 
which  seemed  likely  to  be  most  helpful.  At  the  close  of  the  next 
day  your  Committee  again  met  and  discussed  the  work  of  the  day, 
and  new  assignments  were  made  for  the  morrow.  In  this  way  we 
were  able  to  get  reports  from  several  sessions  and  from  different 
sections  of  the  Congress. 

Medical  and  hygienic  science  have,  in  recent  years,  made  enor¬ 
mous  strides  both  in  the  control  and  prevention  of  many  forms  of 
disease;  yet  such  scientific  knowledge  cannot  be  advantageously 
made  use  of  without  reliable  vital  statistics.  The  same  principles 
apply  as  in  private  business  affairs.  If  an  expert  is  employed  to 
advise  a  manufacturer  with  reference  to  the  condition  of  his  affairs, 
he  will  at  once  ask  to  see  the  books.  He  cannot  advise  as  to  the 
cost  of  production  or  manufacture  of  goods;  or  as  to  the  actual 
present  financial  condition  if  no  books  of  account  have  been  kept, 
and  if  there  are  no  written  records  showing  past  transactions  and 
present  conditions.  A  patient  cannot  be  intelligently  treated  until 
the  physician  has  an  accurate  history  of  the  case.  A  lawyer  cannot 
wisely  advise  a  client  until  all  the  facts  are  furnished  him.  This  is 
so,  and  even  more  so,  in  the  case  of  communities.  In  some  localities 
the  highest  mortality  is  experienced  from  those  diseases  which  are 
now  known  to  be  largely  preventable.  Familiarity  seems  to  breed 
in  this  case  apathy. 

It  is  more  difficult  to  get  a  community  to  make  war  against  some 
disease  which,  notwithstanding  its  high  mortality,  has  been  of  long 
standing  than  it  is  to  induce  the  same  people  to  take  up  arms  against 
an  uncommon  disease  much  less  dangerous.  One  mild  case  of 
smallpox  in  an  adjoining  county  will  cause  more  alarm  than  a  dozen 

3 


cases  of  malarial  or  typhoid  fever  in  the  immediate  community.  In 
many  places,  especially  in  the  South,  the  inhabitants  appear  to  be 
ignorant  of  the  fact  that  they  unnecessarily  suffer  severely  from 
malaria  and  other  diseases  incident  to  improper  sewerage  and  im¬ 
pure  drinking  water;  they  are  indignant  if  told  that  their  mortality 
from  such  causes  is  in  excess  of  that  in  similar  communities  else¬ 
where. 

If  we  can,  by  official  statistics,  convince  any  community  that  it  is 
an  unhealthful  place  in  which  to  live,  and  that  such  fact  will  be  com¬ 
mon  knowledge,  the  local  inhabitants  will  apply  the  remedy. 
Publicity  is  the  most  effective  weapon  that  can  be  employed;  it  is 
a  greater  agent  in  any  reform  than  mere  mandatory  legislation. 
Dr.  W.  S.  Rankin,  of  the  State  Board  of  Health  of  North  Carolina, 
forcibly  demonstrated  in  his  address  before  the  Section  on  Demog¬ 
raphy  at  Washington,  the  great  importance  of  reliable  vital  statistics 
in  removing  insanitary  local  conditions.  Dr.  Rankin  has  consented  to 
address  this  meeting,  and  will  furnish  you  such  information  at  first 
hand. 

It  is  to  be  hoped  that  every  member  of  this  Association  will  hear 
or  read  Dr.  Rankin’s  address,  and  also  the  papers  read  at  Wash¬ 
ington  by  Dr.  Dowling  of  the  State  Board  of  Health  of  Louisiana, 
Dr.  Plecker,  Director  of  the  Bureau  of  Vital  Statistics  of  Virginia, 
and  Dr.  Snow  of  the  State  Board  of  Health  of  California. 

The  most  valuable  asset  of  a  man,  a  family,  or  a  community  is 
good  health. 

The  total  population  of  a  Nation  is  the  aggregate  of  many  single 
units.  It  follows,  therefore,  that  our  problem  is  with  the  individual. 
If  he  is  suffering  from  a  disease,  and  his  neighbors  are  dying,  or 
have  died,  from  the  same  cause,  we  must  be  able  to  find  him,  before 
we  can  cure  him,  or  remove  the  cause.  This  cannot  be  done  without 
reliable  vital  statistics. 

The  difficulty  of  securing  necessary  legislation  in  some  States  is 
well  known.  The  National  Government  and  the  American  Medical 
Association,  among  other  agencies,  are  striving  to  secure  adequate 
and  uniform  laws  in  all  the  States. 

In  a  bulletin  recently  issued  by  the  American  Medical  Association, 
this  statement  appears — 

“The  present  condition  of  the  registration  of  vital  statistics  in 
the  United  States,  considering  the  country  as  a  whole,  is  not  far 
from  constituting  a  national  disgrace.  Unlike  practically  all  other 

4 


civilized  countries,  we  have  no  general  and  thorough  system  for 
recording  the  chief  events  of  human  life,  and  especially  the  births 
of  our  children  and  the  deaths  of  our  people.  .  .  .  Honest  data, 
fairly  presented,  will  remove  the  imputation  of  unhealthfulness  from 
many  localities  now  tainted  by  the  apprehension  of  insanitary  con¬ 
ditions  in  the  minds  of  possible  incomers.  Intelligent  immigration 
will  not  go  where  the  conditions  of  civilization  are  so  slack  that  no 
regard  is  paid  to  human  life,  even  so  much  as  to  record  its  beginnings 
and  endings.” 

Vital  statistics  kept  by  cities  and  counties,  without  regard  to 
standard  forms  making  comparisons  possible,  have  proven  to  be 
unsatisfactory.  It  is  common  knowledge  that  well-managed  life  in¬ 
surance  companies  will  not  accept  risks  in  sections  known  to  have 
excessive  mortality.  Every  company  properly  spends  time  and 
money  to  determine  in  advance  those  parts  of  the  country  which 
have  an  abnormal  death  rate.  Prior  investigation  is  more  economical 
than  the  payment  of  death  claims  on  policies  imprudently  issued. 
Reliable  information  should  be  available  from  the  public  records. 

Some  States  have  no  law  requiring  a  registration  of  vital  statis¬ 
tics  ;  in  other  States  the  laws  are  inadequate ;  and  in  still  others  the 
laws  so  far  have  not  been  effectively  enforced.  Attention  is  invited 
to  a  map  in  colors  printed  on  the  last  page  of  the  cover  of  this  report. 

There  are  sections  of  the  country  where  the  people  rebel  against 
a  public  record  being  made  of  the  births  of  their  children,  and  the 
deaths  of  their  people.  They  say  that  they  and  their  ancestors  never 
have  been  compelled  to  furnish  such  information  to  a  curious  public, 
and  that  they  will  not  do  it  now ;  yet  these  same  people  will  not  buy 
a  horse  or  a  cow  unless  the  parentage  or  pedigree  is  a  matter  of 
record. 

The  Director  of  the  Census  in  a  recent  publication  says — 

“It  seems  to  me  that  there  is  almost  nothing  more  important  in 
the  entire  field  of  statistics  than  vital  statistics,  because  of  their  di¬ 
rect  bearing  on  the  health  and  consequent  welfare  of  the  people. 
It  certainly  is  both  strange  and  shameful  that  the  United  States 
should  be  so  far  behind  the  other  leading  countries  of  the  world  in 
the  registration  of  deaths,  and  even  more  so  in  the  registration  of 
births.” 

We  wish  to  offer  the  testimony  of  three  well-known  authorities 
for  the  purpose  of  emphasizing  the  great  value  of  vital  statistics  to 
preventive  medicine,  and  for  the  prolongation  of  human  life. 

5 


Assistant  Surgeon  General  Trask,  in  a  recent  publication  by  the 
United  States  Government,  makes  this  statement — 

“A  community  which  has  no  means  of  knowing  with  what  con¬ 
tagious  diseases  it  is  afflicted,  nor  how  many  cases  there  are,  nor 
where  they  are,  is  helpless  to  protect  itself,  and  unnecessary  sickness 
and  death  will  result.” 

Dr.  Wm.  H.  Allen,  in  a  paper  read  at  Harrisburg  a  few  years  ago, 
said — 

“The  earnest,  intelligent  health  officer  relies  upon  statistics  for  an 
understanding  of  his  field.  A  tax  collector  can  not  discharge  his 
duties  unless  he  knows  the  address  of  every  debtor.  A  police  bureau 
can  not  protect  society  unless  it  knows  the  character  and  haunts  of 
the  degenerates.  A  health  officer  can  not  execute  the  law  for  the 
protection  of  society’s  health  unless  he  knows  the  haunts  and  habits 
of  disease.  For  this  he  must  look  to  vital  statistics. 

“But  the  greatest  service  of  vital  statistics  is  their  educational 
influence.  .  .  .  Wherever  statistics  are  wanting,  sanitary  adminis¬ 
tration  is  defective.  Wherever  they  are  complete,  sanitary  adminis¬ 
tration  is  efficient.  Defective  vital  statistics  and  low  ideals  of 
cleanliness  and  health  go  hand  in  hand.” 

Dr.  John  S.  Fulton,  Secretary  of  the  State  Board  of  Health  of 
Maryland,  in  a  paper  read  before  the  American  Medical  Association, 
said — 

“Public  hygiene  is  built  upon,  is  controlled  and  directed  by,  and 
is  everlastingly  in  debt  to  vital  statistics.  .  .  .  Every  wheel  that 
turns  in  the  service  of  public  health  must  be  belted  to  this  shaft, 
otherwise  preventive  medicine  must  remain  invertebrate  and  unable 
to  realize  the  profits  available  from  the  magnificent  offerings  of  col¬ 
lateral  science.” 

The  value  of  accurate  vital  statistics  to  the  fundamental  principles 
underlying  life  insurance  is  too  well  known  to  require  mention  even, 
to  this  audience. 

Your  Committee  believes  that  it  is  within  the  province  and  within 
the  power  of  the  Association  materially  to  assist  in  the  passage  and 
enforcement  of  proper  laws  for  the  securing  of  vital  statistics  in  the 
United  States,  and  that  such  work  is  both  tangible  and  important. 

We  believe  that  the  Association  should  continue  its  custom  of  in¬ 
viting  well-known  public  men  and  experts  to  give  addresses  at  our 
annual  meetings  on  the  different  phases  of  health  conservation  and 
hygiene ;  and  that  wide  publicity  should  be  given  to  the  same. 

6 


We  recommend,  however,  that  for  the  present  the  Association 
give  particular  attention  and  such  assistance  as  lies  within  its  power 
to  the  passage  and  enforcement  of  proper  and  necessary  laws  for  the 
registration,  preservation,  and  compilation  of  vital  statistics;  and 
that  a  reasonable  sum  of  money  be  expended  for  such  purposes. 

F.  W.  Jenkins,  Chairman , 

President,  Security  Mutual  Life  Insurance 
Company,  Binghamton,  N.  Y. 

J.  R.  Clark, 

President,  Union  Central  Life  Insurance 
Company,  Cincinnati,  Ohio. 

W.  F.  Dix, 

Secretary,  The  Mutual  Life  Insurance 

Company,  New  York  City. 

J.  L.  English, 

Vice-President,  ^Etna  Life  Insurance 

Company,  Hartford,  Conn. 

John  K.  Gore, 

Vice-President  and  Actuary,  The  Pru¬ 
dential  Insurance  Co.,  Newark,  N.  J. 

Dr.  A.  S.  Knight, 

Medical  Director,  Metropolitan  Life 

Insurance  Company,  New  York  City. 

Edgar  S.  Scott, 

President,  Franklin  Life  Insurance 

Company,  Springfield,  Ill. 

Dated  December  5th,  1912. 


At  the  concluding  session  of  the  Sixth  Annual  Convention  of  the 
Association  of  Life  Insurance  Presidents,  held  on  the  afternoon  of 
Friday,  December  6,  1912,  the  following  resolution  was  unanimously 
adopted : 

“Resolved,  That  the  report  of  the  Health  Committee  be  com¬ 
mended  and  its  recommendations  adopted.” 


7 


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I 


* 

. 

la  ..  ,  ,  _  3  0112  105540345 

^Betterment  of  ILtfe  3n»Uiaiuc  *>eroice 

Map  Showing  Use  of 

The  Standard  Certificate  of  Death,  1912 

C Prepared  by  Association  of  Life  Insurance  Presidents  from  data  furnished  !:v  the 


Registration  States  using  the  Standard  Certificate. 


The  United  States  Standard  Certificate  of  Death  was  adopted  in  1902  ; 
vised  by  the  American  Public  Health  Association  and  approved  by  the  U, 
Bureau  of  the  Census,  for  use  beginning  January  1,  1910. 

Prior  to  the  use  of  the  standard  blank  no  two  States  (and  hardly  any 
cities)  in  the  United  States  had  the  same  forms.  No  uniform  instructions  co 
be  given,  and  exact  comparability  of  returns  was  impossible. 


Nonregistration  States  using  or  recommending  the  Standard  Certificate. 


Registration  States  that  have  made  no  changes  in  certificates  since  the  adoptitk 
the  Standard  Certificate  in  1902;  they  still  retain  the  old  blanks  (of  excel 
form),  but  will  presumably  unite  with  the  States  using  the  Standard  Certi 
when  a  change  is  made. 


Nonregistration  States  that  have  adopted  new  blanks  since  1902,  and  have 
adopted  the  Standard  Certificate. 


States  left  uncolored  have  no  State  laws  (Arkansas,  Georgia,  South  Carolim 
laws  of  such  unsatisfactory  character  that  the  Standard  Certificate  could  not  be  u] 
Registration  States  are  those  in  which,  in  the  opinion  of  the  Bureau  of 
Census,  at  least  90^  of  all  deaths  are  registered. 

Nonregistration  States  are  those  in  which  the  registration  is  below  90$, 
which  the  adoption  of  the  Standard  Certificate  has  been  too  recent  to  : 
judgment  as  to  the  completeness  of  registration. 


